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缺氧( hypoxia). 第一节 概述 一.氧的摄取、输送和利用. 缺氧:供氧↓或用氧异常→代谢、功能、甚至形态结构都可能发生异常变化的病理过程。. 一.常用的血氧指标: 1.血氧分压 ( partial pressure of oxygen, PO 2 ): 定义:溶解于血液的氧所产生的张力. 正常值: PaO 2 :100mmHg (13.3kPa) PvO 2 :40mmHg (5.33kPa). 影响因素 :. PaO 2 : 吸入气氧分压和肺呼吸功能 PvO 2 : 可反映内呼吸状态.

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缺氧( hypoxia)

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Hypoxia
hypoxia


Hypoxia
.


Hypoxia


1 partial pressure of oxygen po 2
.1.partial pressure of oxygen, PO2:


Pao 2 100mmhg 13 3kpa pvo 2 40mmhg 5 33kpa
PaO2:100mmHg (13.3kPa) PvO2:40mmHg (5.33kPa)


Hypoxia

PaO2:

PvO2:


2 oxygen binding capacity co 2 max 100 ml hb co 2 max 1 34 ml g hb 15g dl 20 ml dl
2.(oxygen binding capacity, CO2max100mlHb:CO2max=1.34(ml/g)Hb(15g/dl) 20 ml/dl


Hypoxia
Hb


3 oxygen content co 2 100 ml o 2 hb 0 3 ml dl
3.oxygen content, CO2:100mlO2 Hb() (0.3ml/dl)


Cao 2 19 ml dl cvo 2 14 ml dl
CaO2 19 ml/dlCvO2 14 ml/dl

PO2Hb


4 so 2 hb co 2 co 2 so 2 co 2 max 100 co 2 max 100
4.SO2HbCO2- CO2SO2= CO2max 100% = CO2max 100%


Sao 2 98 svo 2 70
SaO2 98% SvO2 70%

PO2


Odc so 2 po 2 s
(ODCSO2PO2S


2 3 dpg h pco 2
2,3DPG [H+] PCO2

HbO2

HbO2


5 cao 2 cvo 2 100 5 ml dl
5. -CaO2-CvO21005ml/dl



O 2 pao 2 cao 2 o 2 cao 2
O2PaO2CaO2O2(= CaO2)


Hypoxia

(1)(

(2)(

(3)


Hypoxia

PaO2 CO2max CaO2 SaO2 CaO2CvO2 N CaO2CvO2 : N()


Cyanosis
(cyanosis)

>50g/L,


Hypoxia
(

HbCO2maxCaO2O2(= CaO2)


1 2 co hbco o 2 hbo 2 co
(1)(2)CO HbCO + O2HbO2+ CO


A co hbfe 2 hbfe 2 co
a.CO + HbFe2+HbFe2+CO,;

b.COHbO2210,COHb;


Hypoxia

c.CO2,3DPG,HbO2;


3 hb fe 2 hbfe 3 oh
(3) HbFe2+HbFe3+OH


A mhb fe 3 oh
a.MHbFe3+OH

b.


Hypoxia
( ) MHb


4 hb a 2 3 dpg b ph c hb
(4)Hb:a.2,3DPGb.pHc.Hb


Pao 2 co 2 max cao 2 sao 2 cao 2 cvo 2 n n
PaO2 CO2max CaO2 SaO2 CaO2CvO2 N N


Hypoxia

CO()or

MHbor


O 2 o 2
O2 () O2


Hypoxia
(1)(2)


Pao 2 co 2 max cao 2 sao 2 cao 2 cvo 2 n n n n
PaO2 CO2max CaO2 SaO2 CaO2CvO2 N N N N


O 2 o 21
O2O2


Hypoxia
(1)(): (CN),


Cn cytaa 3 fe 3 cytaa 3 fe 3 cn

Cytaa3Fe3+ Cytaa3Fe2+

CN+ Cytaa3Fe3+Cytaa3Fe3+CN,


2 3 vitb 1 b 2 pp
(2)/ (3) VitB1B2PP


Hypoxia

PaO2 CO2max CaO2 SaO2 CaO2CvO2N N N N (HbO2)


Hypoxia

: ;


Cao 2
CaO2


Pao 2 60mmhg
.()PaO2(<60mmHg)


Hypoxia

*


1 2 3 4
.1. 2. 3. 4.


1 1 2 3
1.(1)()(2)(3)


Hypoxia
2.

(1)

(2) ()


Hypoxia

3. (1)(2)LTs,TXA2,ET(3)Ca2+Na+



4 vegf
4. VEGF


Hypoxia
()

1.

(1):

(2) EPO


2 2 3 dpg
2. 2,3-DPG

(1)2,3-DPG,,

(2)2,3-DPGpHBohr


Hypoxia
?

Hb


Hypoxia


1 2 3 41
1.:,2.3.4.


Hypoxia


Hypoxia


Hypoxia
.()

1.

Na+Ca2+K+

2.

3.


Hypoxia
()CNS()


1 2 3 42
()1.2.3.4.


1 cns 2
1.CNS; 2. /


Pio 2 pao 2 sao 2 cao 2
:PiO2PaO2SaO2CaO2


Hypoxia

  • CO;


Hypoxia
>0.5


1 1 8 2 2 3
(1) (1 8)(2) 2~3


1 5 2 2001 8 3 2002 8
1..5. 2..( ).,2001,83.. .20028


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